Category: Nurse

Stress Management and Nurse Burnout Syndrome

Nursing is a particularly high-stress profession, emotionally challenging and physically draining, with a high occurrence of burnout. In addition to the negative effects of stress on nurses’ health and well-being, stress is also a major contributor to attrition and common shortages in the nursing profession. Stress, which can lead to depression and burnout, is an epidemic in nursing, but no one will talk about it. According to the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI), “nurses experience high stress and clinical depression at twice the rate of the general public” (2016).

Stress affects 9% of everyday citizens, but 18% of nurses experience symptoms of depression and stress. A study will be conducted to explore the following idea, “In registered nurses who work in busy city hospitals, do the nurses who practice stress management compared to the nurses who do not practice stress management have a decreased level of burnout syndrome?” A quantitative research study will be conducted using nurses who work at a local inner city hospital in North Philadelphia, that work in the ICU, med surg, and Covid floors. An evaluation of recent literature will be reviewed that outlines this nationwide issue. The purpose of this study is to evaluate the effectiveness of stress management for nurses who practice these skills, as opposed to the nurses who do not use stress management to avoid burnout. This study may result in better coping skills for nurses who work in busy city hospitals, who deal with the stresses of being burnt out.

Stress and burnout are perceptions that have sustained the attention of nurses and researchers for several years. These perceptions are highly relevant to the workforce in general and nursing in particular. Both quantity and quality of nursing care may be unpleasantly affected by stress and burnout. Registered nurses working in busy hospitals who perceived high levels of work-related stress were rated lower in work performance by supervisors and colleagues. According to the Journal of Applied Biobehavioral Research (2013), “stressors in the workplace may result in a burnout syndrome and burnout results in low productivity”. Burnout syndrome is the continuous exposure to work-stress associated with poor working conditions, in which pleasure and work performance decrease (Gasparino 2015). According to the World Health Organization, mental health can be considered as a state of well-being in which the person is able to use their own resources and abilities to recuperate from the stress of everyday life, without compromising productivity. Stress is a system of adaptation of the individual to any unanticipated situation and arranges them for a quick and effective action.

Thus, nursing is one of the most stressful professions. It is common to see burnout syndrome in health experts, especially in the field of nursing (Markwell 2015). Some experts are able to deal with the symptoms, but those who don’t adjust to the long-term working surroundings, inadequate number of professionals, and poor communication tend to feel physically and emotionally wiped out (Darban 2018). For nurses, burnout reduces the capability to provide care. Every day, nurses face the dilemma of being human, empathetic, and sensitive, in a work environment of many responsibilities.

Using the PDSA Cycle in a Nursing Quality Improvement Proposal: Critical Essay

Nurse safety is an essential factor of consideration in ensuring the delivery of safe and quality care within an acute mental health setting. According to the Work Health Safety Act (2011), employers are legally obliged to provide a safe workplace as well as comply with the responsibility of protecting workers and all healthcare staff from harm. Aggression and violence toward nurses have detrimental effects on the ability of nurses to care for consumers effectively (Kelly, Fenwick, Brekke, & Novaco, 2016). Therefore, the need to address this issue will not only benefit healthcare workers but also those who are receiving care. My quality improvement proposal is to employ a 2-nurse ratio. Therefore, instead of having a traditional 1:5 ratio, it will be a 2:10 ratio. This proposal aims to increase nurse safety and increase the standard of patient care. It will ensure that when nurses attend to patients outside of the secure nurse station, they will go in pairs. The proposal will be implemented at the acute mental health unit where I conducted placement. This essay will first critically review and appraise recent evidence surrounding the need for quality improvement. I will then hypothetically implement my change using the plan, do, study, and act cycle (PDSA). I will analyze leadership and management concepts vital for successful implementation. And lastly, critically appraise my quality improvement.

During a placement at one of Canberra’s secure acute mental health units, I saw firsthand aggression and violence aimed toward healthcare staff daily. Frequently I was asked to accompany nurses to attend patient care. There was an obvious feeling of fear for one’s personal safety when attending aggressive and agitated patients alone. Addressing violence and aggression in mental health units can be complex and multi-faceted. Improvements already employed within the unit consisted of CCTV, security, personal duress alarms, and extensive interpersonal de-escalation training.

Justification

Aggression and violence towards healthcare staff in mental health facilities have been comprehensively researched with consistent findings that 70% of mental health nurses have been physically assaulted and 88%-100% of mental health nurses have experienced verbal aggression (Kelly et al., 2016; Foster, Roche, Giandinoto & Furness, 2019). Edward et al. (2015) conducted an international systematic review that found mental health nurses were three times more likely to be physically assaulted than general hospital nurses. This statistic was much more conservative in comparison to others published. Furthermore, the review suggested this may be having detrimental effects on the recruitment and retention of mental health nurses. Foster et al. (2019) have predicted by 2030, there will be a national shortage of 18,500 mental health nurses in Australia. Local media released just last year revealed mental health nurses in the same unit where I completed a placement have given warnings that their lives are at risk from patient assaults. The assaulted nurses reported insufficient post-incident follow-up, forcing them to either physically withdraw from their work or risk their own safety by deciding to remain within the unit (Scott & Evans, 2018).

Cases of significant injuries and death are rare, although the results of aggression and verbal abuse can result in significant psychological harm to nurses, such as anxiety, fear, depression, as well as post-traumatic stress disorder (Ward, 2018; Itzhaki, 2018). According to the Australian Capital Territory (ACT) Government, between January 2017 and June 2018, there were 139 reported cases of physical assaults towards healthcare staff in Canberra mental healthcare settings (Scott & Evans, 2018). Foster et al. (2019) highlighted that in Australia, the leading cause of workplace stress reported by mental health nurses was aggression and violence from patients to nurses. Safety is vital for all healthcare workers in a mental health setting as it may allow for the development of a close therapeutic relationship which may enhance patient outcomes (Haines, Brown, McCabe, Rogerson & Whittington, 2017).

Lanctot and Guay (2011) highlighted the detrimental consequences physical and verbal aggression had on nurses’ health and well-being. They found that the severity of the aggression and violence played some part, but more importantly, it emphasized how damaging cumulative minor aggressions and violence can have on mental health nurses. A recent ACT Health strategy addressing workplace violence highlighted significant underreporting of incidences (ACT Health, 2018). Therefore, when analyzing the rates of incidences, we must take into account the minor incidences that do not get documented. Violence and aggression negatively affect the professional relationship between nurses and patients by nurses to feel isolated and less empathetic toward patients (Ward, 2018). In a context where therapeutic relationships with patients are so significant in treatment, it is vital to have an understanding of how workplace safety affects the ability of nurses to engage with consumers in their care. According to a recent ACT Health strategy, nurses exposed to violence and aggression productivity decreased by 37%, as well as an overall decrease in workplace morale, increased stress levels, and a decrease in control of emotional reactions (ACT Health, 2018). The literature is quite clear that aggression and violence detrimentally affect a nurse’s well-being and subsequent patient care.

A two-staff-nurse ratio is an ideal quality improvement proposal through which violence and aggression against nurses can be improved and nurse safety enhanced. This proposal is not new and many acute mental health facilities throughout the world have this stipulated within their guidelines (NICE, 2019). Recent research conducted in community health settings concluded nurses working alone were at an increased risk of violence or aggression from patients (Terry, Le, Nguyen & Hoang, 2015). Furthermore, the National Health Service (2015) also found that nurses working alone had a 10% higher incident rate in relation to aggression and violence from their patients. Recent laws have changed in some states of Australia now banning single nurse posts in remote areas due to the increased risk and vulnerability nurses were experiencing working alone. They have also instructed nurses going on call-outs to attend in pairs to increase personal safety (SA Health, 2019). Extensive research has categorically found nurses working alone in community settings had increased risks of aggression and violence. This evidence is out of context, although provides some insight into nurses’ vulnerability when working alone. One study found in acute mental health units the prevalence of violence increased when nurses attended to patients alone (Shu-Fenn Niu, Hsiu-Ting Tsai, Ching-Chiu Kao, Traynor & Chou, 2019). Although this study was conducted in Taiwan, it may add some additional value.

Minimal literature published has focused directly on a 2-nurse staff ratio and its implications on nurse safety within a mental health context. However, one qualitative study from Canada directly assessed the effectiveness of nurses working in pairs in pod nursing. Pizzingrilli & Christensen (2014) looked at pod nursing in an acute mental health unit. Before this implementation took effect, nurses were working alone in a traditional nursing ratio of 1:5. The quality improvement designated 2 nurses to work together, caring for one pod of 10 patients. The study indicated nurses felt safer engaging consumers in their accommodation post-implementation. Furthermore, collaboration between the nurses was enhanced when compared to pre-implementation. Post-implementation survey results found 84.6% of nurses thought patient care was enhanced, and 100% of nurses did not want to move back to the pre-implementation nursing ratios. This study did fail to compare incident rates pre and post-implementation. Also, the design of the unit differs from the facility I wish to implement the specified quality improvement. However, I believe this study has suggested that there were positive changes in perceptions of nurse safety by working in pairs.

Plan, Do, Study, Act Cycle

The objective of this quality improvement is to increase safety for nurses working in acute mental health settings. I will structure my implementation using a PDSA cycle, suggested to be an effective tool when implementing and testing quality improvements. This quality improvement will be carried out at a designated acute secure mental health unit. The change team will consist of three enrolled or registered nurses, three team leaders, CNE, CNC, and a patient advocate. The change team will be encouraged to have regular team meetings throughout implementation. Incorporating all staffing levels within the change team will allow for a better understanding of participants’ perceptions and problems during the implementation of the quality improvement.

Management’s focus during the change process will be on the operational side of the implementation. They will also have a responsibility to collate information and data regarding quality improvement. A transformational leadership concept will be employed because of its documented benefits to changing organizational nursing culture. Utilizing a transformational leadership style, team leaders and nurses will lead by example and influence positive change throughout the nursing staff in order to change cultural norms held within the facility. Leaders will value and encourage peer engagement in the implementation and welcome any suggestions or recommendations.

The first step will be gathering data from the main stakeholders within the facility, this would be mainly the nursing staff working on the floor. Looking retrospectively at incident reports from the past 12 months will give an insight into the pre-implementation rate of incidents. All levels of nurses will be required to fill in a work safety scale survey used in similar implementations to assess perceptions of ward safety. This will give the change team a baseline to compare future results. The patient population within the facility will also be required to fill out a survey detailing their perceptions of care. This will permit the change team to monitor the implementation’s effects on patients’ perceptions of quality care.

The nursing staff, team leaders, and middle management will be briefed in multiple educational meetings on the plan of implementation and why we are implementing change. Evidence supports informing stakeholders of the rationale behind the change to try and get them actively engaged with the change. There will be a focus on a clear and concise vision of the desired outcomes post-implementation with the aim to increase the urgency for change. A patient information session will be held so patients within the facility are informed of the new proposal. This will also allow an opportunity for patients to raise any queries, concerns, or suggestions. High levels of communication and transparency at all levels will be held throughout this process.

The implementation will start during night shifts for the first two weeks, this will allow time to alleviate any problems before implementation during busier shifts. Hughs (2008) has advised when implementing change to utilize a minimalist approach, thus making it easier to make changes prior to implementing the quality improvement throughout the facility. This will be followed by the implementation during the evening shift for one week and finally the morning shift. Four weeks into the implementation, all shifts will be following the new quality improvement. Throughout this process, we will be assessing the effectiveness of this implementation and encouraging feedback from staff and patients. Predicting potential hurdles will allow us to structure a plan that takes these into account, allowing the change team to easily adapt (Hughs, 2008). Research indicates that acute mental health units have had difficulty implementing quality improvements because of staff resistance to change. Laker et al. (2014) highlighted nurses working in direct care positions were more ambivalent to changes. There may also be resistance from patient advocates, as the change may exacerbate negative stigma towards patient conditions (Knaak, Mantler & Szeto, 2017). Well published is the high turnover of staff within acute mental health units, thus posing some difficulties in obtaining consistency in care and knowledge of quality improvement (Lancotot & Guay, 2014).

During implementation, team leaders will record challenges experienced by nurses and patients. Data will be collected throughout the implementation process, such as near misses, incident reports, and stakeholder feedback. After the quality improvement has been implemented for three months, a complete analysis of the collected data will be undertaken. The analysis will be compared to the expected outcomes of quality improvement. Nursing staff and patients will fill out their relevant questionnaires and incident reports will be collated. Multiple meetings will take place to attain qualitative feedback about the proposal, implementation, and general feelings about working in pairs instead of alone. The change team will engage with the patients to see how they have found the change and if it has had any negative or positive effects from their perspective. With the information collected from the trial period, the change team will tailor the quality improvement proposal to maximize its use and benefits. It will be important to be flexible and work in collaboration with stakeholders throughout this process.

Critical Appraisal

The quality improvement proposal aims to enhance nurse safety within the acute mental healthcare facility specified. Due to the complexities surrounding nurse safety, there are several limitations regarding this proposal. The main disadvantage of this proposal is the potential exacerbation of stigma towards those with mental health problems. The impact of stigma towards patients with mental health illnesses is significant and can affect a patient’s recovery and ability to regain normality. Encouraging an increased nurse ratio to increase nurse safety may reinforce negative stereotypes, for example, that mental health patients are all dangerous (Knaak et al., 2016). It may also split the population creating us and them mentality. This is something I definitely do not want to create with this proposal, however, there is a fine balance that needs to be created between nurse safety and fostering a recovery-focused environment.

Staff may be resistant to this change due to the heavy workload nurses face daily. Pairing nurses together may impede their ability to complete daily tasks effectively and increase levels of stress. Maharaj, Lees & Lai (2019) found a high prevalence of depression, anxiety, and stress among Australian nurses. A thorough thought-out plan and supportive team will mitigate the risk of causing burnout to nurses. The aspect of a cost/benefit analysis has not been considered to be of primary importance, although it is recognized that the impact of a 2:10 nursing ratio will have significant monetary consequences. The most important element in the proposal to be undertaken is the need to ensure that nurses working in a potentially aggressive and hostile environment are protected from the unwanted attention of a violent nature. As well the mental health and well-being of patients will need to be at the forefront of any planned changes in order to assuage any fears held by them.

Conclusion

All modern healthcare facilities should be fostering an environment that encourages the continued development of research, leading to the maximization of quality care within those facilities. Year after year violence-related incidents in healthcare continue to rise. There is an urgent need to address this issue so that nurses may feel safe when delivering person-centered care. This proposal has highlighted a complex problem that may be addressed by implementing a two-nurse ratio in acute mental health units. I have hypothetically planned a quality improvement and highlighted some management and leadership concepts that will help with the successful implementation. Violence against healthcare workers not only has negative impacts on the psychological and physical well-being of nurses but also on job motivation, retention of highly qualified staff, and the future recruitment of suitable persons for a sometimes difficult career. Finally, the time has arrived whereby healthcare leaders and administrators will need to take a nurse-centered management approach to address the many complex issues affecting the delivery of quality care.

Time Management Essay on Nursing

Introduction

The aim of this essay is to present a reflective account of my role as a student Nurse and as a future healthcare practitioner with a one-year action plan for a developmental need. I will discuss first learning in higher education, studying for a Nursing degree, and my roles as a future Healthcare practitioner. I will confer on nursing in current healthcare and the Value of lifelong learning. This will be followed by my initial reflections on entering higher education. I will discuss my academic profile and identify my learning style and the impact this has on my learning. This will be followed by a discussion on my area of development in relation to Essential Skills in higher education and a reflection on its significance in my practice as a student and future nurse. This essay will end with a conclusion that summarises all points discussed and the recommendation of what needs to be done in light of the findings. Reflection helps both student nurses and healthcare practitioners to enhance current and future nursing practice through learning from one’s experiences (Bulman and Schutz, 2013)

Discussion

It’s my first year at university and it has been an exciting experience so far. The diversity in culture and religion that make up the school community attracts an array of students from different backgrounds. The learning experience at higher education is one that will provide me with the skills I need as a student in practice and also as a future Healthcare practitioner; as I am strengthened through rigorous reading and research on various topics, to think independently, and also question what I read and learn. My first few weeks of attending classes confirmed that my choice to study mental health nursing was the right decision for me. Answers to questions I had always wondered about concerning nursing were taught and I found this particularly intriguing, as I hadn’t previously studied it.

I effectively manage my time to ensure that I meet all the program requirements for the completion of theory hours, practice hours, and theoretical and practice-based assessments. As a student nurse am expected to effectively manage the continual transition between my role as a health care support worker and my role as a student nurse. Am required as a student nurse to understand what it means to be a registered professional and how keeping to the Code helps to achieve that … these guidelines (Nursing and Midwifery Council [NMC], 2018). The patient is my first priority as a future Healthcare practitioner. My role as a future nurse is to advocate for the best interests of the patient and to uphold the patient’s dignity through treatment and care. This may include educating patients about the management of illnesses, collaborating with other health professionals, and making suggestions in the treatment plan of patients (Temple, J. 2012). Other roles are administering medications and treatments, Monitoring patient health, and recording signs. I am committed to upholding the standards as stipulated in the NMC (2018); this commitment to professional standards is fundamental to being part of this noble profession.

There are many urgent Healthcare issues that need to be addressed as recognized by stakeholders nationally and internationally. Global population Health has drawn the concern of the World Health Organization (WHO); in light of this, it encourages healthcare providers to work collaboratively for solutions to improve the lives of people around the world especially the underserved. Nurses must, however, rapidly adapt as medicine, technology, and societal health concerns change. While this swift pace is a good thing in some ways, it also means that the problems the healthcare professionals encounter are constantly changing too. Given that nurses are part of the most integral members of the healthcare community; this is especially true for them. Continuing professional development is imperative because it ensures that as a professional nurse, I will continue to be competent in the profession. It is an ongoing process and continues throughout a professional’s career. The ultimate value of well-planned life-long learning for professional development is that it safeguards the public, the employer, the professional, and the professional’s career. Lifelong learning ensures that as a nurse my knowledge stays relevant and up to date.

The University’s motto struck a chord with me, as the Career University, before I’d even set foot on its beautiful campus. I knew I would have to work had to come out in flying colours and I was prepared. What seemed like fun at the start of the course has now turned into what I fear the most; low grades. I have been trying to keep my grades up but to no avail. I felt I could manage my studies, extra-curricular activities, and most importantly the challenges of studying with work and family life. I feel am distracted by other commitments, but I feel I can still get it right if I take the right steps. I don’t think I prioritize my various activities well, there should be a balance that will leave me stress-free at the end. Although my academic effort has been relentless, I am punctual and I do all my course work too. If I had been more careful in planning my time, instead of being disorganized, I would have done better. With excellent time management skills, I can get my grades up and put my life on track.

I have a BA. Ed English, however, I discovered my calling to be in the field of nursing so I did a diploma in mental health and social care level 4. My prior studies gave me a good foundation to build on my nursing career. I will attribute this to my strengths and the willingness to go the extra mile. I was always punctual in every class we had, even on days that I was a little under the weather I still made it to class. My core strengths are teamwork, strong work ethic, and problem-solving. I would say my learning style is more Kinesthetic and Auditory I learn better when I can move my body, and use my hands and sense of touch like in practical classes or placement (Schmeck, R. 2013). Writing or drawing diagrams are physical activities that I do to improve my learning as well, I also tend to grasp what I hear during lectures or recorded lectures.

As a nursing student, my schedule is hectic. Sometimes I regard my present school as the hardest thing I’ve ever done; I juggle all the responsibilities of school, my family life, and work. Using Gibbs’ reflective model I was able to explore my situation and then identified ‘Time management’ as an area of development in relation to Essential Skills. Time management doesn’t just benefit me as a future nurse; it can also be a big stress relief for me now as a student nurse with the high pace of study and the challenges at work and home. Knowing how to prioritize all my tasks and keeping track of my to-dos on the three fronts can make a big difference in lowering my stress and helping me to better manage my time. Improving my time management skills will make me a more efficient nurse in the future, one that will be capable of attending to the needs of more patients in less time. This doesn’t mean that I will sacrifice patient care and bedside manner; it’s just that I will be able to complete the basic care they need in an efficient way that takes less time. In some cases, I may even get more time to speak with and get to know those that I am caring for by the application of excellent time management skills.